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Mrs. Bunny, The Clown Agreement
ONLINE
Customer Information

Name:_______________________________________  Address:_____________________________________

City/State/Zip:______________________________________________  Phone:_________________ Cell:_________________

Date of Event: ___________   Contact Name & Phone:____________________________________ (if different from customer)
                                                                                                                                                                                                              
Event Address:_____________________________________ City/State/Zip:__________________________________________ 

My Start Time: ________  My End Time: _________    Name of Recipient:______________________________

Check Your Choice(s)

___Basic-1 hr. $125 (up to 15 kids)     ___Bonus-1 ˝ hr. $185 (16-22 kids)     ___Deluxe-2 hrs. $235 (23-30 kids)     ___Magic Show $60

___Large Events $300.00 (2 hr. minimum)     ___Non-Profit $180 (2 hr. minimum)    Singing Telegrams: ___Child $35     ___Adult $55

Extras:   ___Hour $110    ___ ˝ Hour $60   ___Drive Time $10    ___Last Minute Fee $10

Deposit:______________              Remaining Balance:____________     Total Amount: ______________ 

___Cash    ___Paypal.com    *___ Money order/check #________________________________________ *Payable to:

Cheryl M. Henderson
6623 Alder Avenue
Berkeley, MO 63134

To cancel, please call within 48 hrs. of event to receive your refund.  Refunds are in the same mode as payment (minus $25 schedule fee).  
$35.00 returned check fee in addition to all applicable bank fees. 

How many children? ____________                 Special Instructions _________________________________________
Is the party: Inside___ Outside___                    Notes_____________________________________________________

The Agreement:

“With our signatures, the customer and I, Cheryl M. Henderson, aka Mrs. Bunny, The Clown, agree that
I will provide the service and the customer will pay the agreed upon fee 14 days before event date.”

Customer: Print_________________________________________ /Sign________________________________________
Today’s Date____________

Cheryl M. Henderson’s Signature_____________________________________ Today’s Date:__________

You will receive a receipt for each payment and the confirmation card with your final payment

Any questions? Contact Cheryl M. Henderson 314-522-9978 or 314-750-7094 (10a-10p, Mon-Sun)

“Say-It-With-Song, Inc.” is a Christian-based service and reserves the right to refuse any engagement that it deems spiritually unhealthy.

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CA01/12


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